Triangulating stapling technique for esophagogastrostomy after minimally invasive esophagectomy

• Published in: Surgery Vol. 154; no. 3; pp. 604 - 610
• Main Authors: Noshiro, Hirokazu, MD, PhD, Urata, Masako, MD, Ikeda, Osamu, MD, PhD, Iwasaki, Hironori, MD, Nabae, Toshinaga, MD, PhD, Uchiyama, Akihiko, MD, PhD, Nagai, Eishi, MD, PhD, Tanaka, Masao, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2013
• Subjects: Aged; Anastomosis, Surgical - methods; Esophageal Neoplasms - surgery; Esophagectomy - methods; Female; Gastrostomy - methods; Humans; Logistic Models; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Prospective Studies; Surgery; Surgical Stapling - methods
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2013.04.007

Background The triangulating stapling technique is one of the reconstruction methods used that provides favorable surgical outcomes in several areas of the digestive tract. However, the results in the cervical esophagogastric anastomosis are not well documented. Methods Using a prospectively maintained comprehensive database, we reviewed the surgical results of 160 consecutive patients who underwent minimally invasive esophagectomy followed by cervical triangulating stapling esophagogastrostomy during 2 periods from May 2002 to May 2012 so as to determine the efficacy of the triangulating stapling technique using 2 different types of stapling devices. Results The rates of anastomotic leakage and stricture in this series were low (1% and 15%, respectively). The rate of anastomotic stricture was significantly reduced when a linear stapler with a cutting knife was used (9%). A logistic regression analysis showed a reduction of anastomotic stricture to be significantly associated with the use of only a linear stapler with a cutting knife. Conclusion Cervical esophagogastric anastomosis by the triangulating stapling technique is safe and feasible. We consider a linear stapling device equipped with a cutting knife to be more suitable for performing the triangulating stapling technique.